01.01.2012 Sex between men – towards better sexual health

New publication: On 1 December the Federal Office of Public Health issued a brochure entitled «Sex unter Männern: Für eine bessere sexuelle Gesundheit 2012» [Sex between men: towards better sexual health 2012]. This brochure reviews the current facts and figures on the HIV epidemic among gay men and other men who have sex with men (MSM). It provides the framework of the strategy set out in the «Urgent Action Plan 2012».

Pictures Sex between men – towards better sexual health

TODO CHRISTIAN

The number of new HIV infections among gay men and other MSM has continuously risen since 2002. This development is the outcome of several factors. On the one hand, a growing number of gay men and other MSM engage in unprotected anal sex with their long-term partner (most of them take an HIV test to exclude an HIV infection) and with their regular casual partners. The growing trust between regular casual partners can cause MSM to stop systematically using condoms. Indeed, the temptation to abandon the condom use naturally arises when regular casual partners are also tested negative for HIV. These multiple relationships of «trust» give rise to a network of individuals who are lulled into a «false» sense of security and engage in unprotected sexual intercourse. It then takes only one newly infected member of this network for the virus to spread rapidly throughout it. One is 20 to 100 times more infectious during the first three months of infection (so called primary HIV infection phase) than during the latent phase. It is then very easy to transmit HIV in this acute phase if the safer sex rules are not respected. On the other hand, the growing effectiveness of antiretroviral treatment and the absence of the threat of death, that had always played a preventive role, have led to a «normalisation» of HIV and its classification as a chronic infection. This process of normalisation has encouraged some gay men and other MSM to stop systematically protecting themselves. Although someone taking effective therapy is highly unlikely to transmit HIV, the beneficial effects of antiretro­viral therapies appear to be offset by the steady increase in risk-taking (i.e. unprotected anal intercourse with several partners). The Federal Office of Public Health (FOPH) has commissioned  the development of a mathematical model that indicates what has driven the HIV epidemic to date and evaluates the various potential scenarios in the future. The results of this model substantiate the hypothesis that treatment – even if instituted very rapidly – is not sufficient to radically reduce the incidence of HIV in this target group. The model also advances the hypotheses that approximately 13% of MSM are unaware of being HIV-positive and are the origin of about 80% of the new infections. MSM are diagnosed an average of two years after their infection, and the number of MSM receiving treatment could almost double in the next ten years unless current prevention activities are adapted.

Urgent Action Plan 2012
In the light of these findings, the FOPH believes that half the new cases of HIV transmission stem from subjects in the primary infection phase, while a third occur in the latent phase, i.e. when the infected subjects have emerged from the primary infection phase but have not (yet) been tested as positive. The remaining cases of HIV transmission stem from subjects whose infection has been diagnosed. This hypothesis prompted the FOPH to draw up its MSM strategy, «Urgent Action Plan 2012». This strategy encompasses three areas of activity. The first aims to break the chain of primary infections and massively reduce the overall viral load in the gay community. To achieve this goal the FOPH, with the help of its partners, will seek to motivate gay men and other MSM to actively participate for one month each year in lowering their viral load and in reducing the risks associated with the setting in which they engage in sexual contacts. This participation does not necessarily mean the  systematic practice of safer sex. It can also be expressed in other ways, for instance by restricting sexual intercourse exclusively to long-term partners during the action month, by refraining from trips to large cities in Switzerland or elsewhere in Europe where there are gay scenes with a high prevalence of HIV, or by not using drugs that have an influence on risk-taking behaviour, etc. The second area of activity aims at reducing the time between an infection and its diagnosis to twelve months. Gay men and other MSM who are not into a monogamous relationship are  recommended to seek counselling testing at least once a year for HIV, syphilis, gonorrhea, chlamydia and hepatitis. The third area of activity seeks to improve the treatment of HIV-positive subjects and prevent transmission of the virus to long-term and casual sex partners. This area also aims to normalise voluntary information to partners when a sexually transmitted disease is diagnosed so they can receive counselling and testing even in the absence of symptoms.

Contact

Steven Derendinger, Prevention and Promotion Section, steven.derendinger@bag.admin.ch,

Roger Staub, head of Prevention and Promotion Section, roger.staub@bag.admin.ch

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